Open AccessClinical manifestation of multiple wasp stings with details of whole transcriptome analysis
Author(s) -
Wei-Fan Ou,
Wei-Chieh Huang,
HsienFu Chiu,
Yan-Chiao Mao,
MeiChin Wen,
ChengHsu Chen,
Sheng-Jou Hung,
Ming-Ju Wu,
ChiehLiang Wu,
WenCheng Chao
Publication year - 2021
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000024492
Subject(s) - medicine , rhabdomyolysis , ards , systemic inflammatory response syndrome , acute kidney injury , insect bites and stings , sting , dialysis , hemodialysis , intensive care medicine , sepsis , immunology , lung , engineering , aerospace engineering
Multiple wasp stings is an emergency result from systemic reactions to the toxin with a wide range of manifestations, and we presented 2 patients with distinct clinical and transcriptomic findings. Patient concerns: Two patients without systemic disease presented with nearly 90 painful papules after attacked by a swarm of wasps ( Vespa basalis ). Diagnosis: Patient 1 was a 44-year-old healthy male whose clinical manifestations mainly comprised hemolysis, hepatic injury, rhabdomyolysis, and acute kidney injury. Patient 2 was a 49-year-old healthy female who presented with severe acute respiratory distress syndrome (ARDS) in addition to certain clinical manifestations that were also found in patient 1. We used ribo- nucleic acid sequencing (RNA-Seq) to characterize the inflammatory responses of 2 patients with distinct clinical manifestations after multiple wasp stings. Interventions: Both 2 patients received 5 sessions of plasmapheresis, and patient-1 further received mechanical ventilation for 8 days as well as 8 sessions of hemodialysis until day 17. Outcomes: Both patients recovered uneventfully after the aforementioned management. We used RNA-Seq to demonstrate a largely regulated neutrophil-predominated immune response in patient 1. In patient 2, we found a profound neutrophilc response on week 1 and a robust neutrophilic as well as pro-inflammatory responses on week 2. Furthermore, we found increased expression of signals that were associated with renal system process on week 2. Conclusion: In conclusion, we report 2 patients who manifested with shared and distinct presentations after an attack by the same swarm of wasps. Both patients had hemolysis, rhabdomyolysis, hepatic injury and acute kidney injury, and 1 patient had ARDS. The whole transcriptomic analyses were consistent with the distinct clinical manifestation, and these results suggest the potential of RNA-Sequencing to disentangle complex inflammatory responses in patients with multiple wasp stings. Plasmapheresis and corticosteroid were administered to both patients and case 2 also underwent 8 sessions of hemodialysis.